Chapter 78 - PUD & Gerd

Question 1

1.	A patient who takes nonsteroidal anti-inflammatory drugs (NSAIDs) for arthritis asks a nurse what can be done to prevent ulcers. The nurse will recommend asking the provider about using which medication?
a.
Antibiotics
b.
Histamine-2 receptor antagonists
c.
Proton pump inhibitors
d.
Mucosal protectants

Answer 1

C

Question 2

2. A patient admitted to the hospital has a history of peptic ulcer disease. The patient takes ranitidine [Zantac] and sucralfate [Carafate]. The patient tells the nurse that discomfort is usually controlled but that symptoms occasionally flare up. What will the nurse do?
   a.
   Ask the provider about ordering an endoscopic examination.
   b.
   Contact the provider to discuss serologic testing and an antibiotic.
   c.
   Contact the provider to discuss switching to a proton pump inhibitor.
   d.
   Counsel the patient to avoid beverages containing caffeine.

Answer 2

B

Question 3

3. A patient newly diagnosed with PUD reports taking low-dose aspirin (ASA) for prevention of cardiovascular disease. The nurse learns that the patient drinks 2 to 3 cups of coffee each day and has a glass of wine with dinner 3 or 4 nights per week. The patient eats three meals a day. The nurse will counsel this patient to:
   a.
   change the meal pattern to five or six smaller meals per day.
   b.
   discontinue taking aspirin, because it can irritate the stomach.
   c.
   stop drinking wine or any other alcoholic beverage.
   d.
   switch to a decaffeinated coffee and reduce the number of servings.

Answer 3

A

Question 4

4. A patient is diagnosed with peptic ulcer disease. The patient is otherwise healthy. The nurse learns that the patient does not smoke and that he drinks 1 or 2 glasses of wine with meals each week. The nurse anticipates that the provider will prescribe which drugs?
   a.
   Amoxicillin [Amoxil], clarithromycin, and omeprazole [Prilosec]
   b.
   Amoxicillin [Amoxil], metronidazole [Flagyl], and cimetidine [Tagamet]
   c.
   Clarithromycin, metronidazole [Flagyl], and omeprazole [Prilosec]
   d.
   Tetracycline, cimetidine [Tagamet], and lansoprazole [Prevacid]

Answer 4

A

Question 5

5. A 30-year-old male patient will begin a three-drug regimen to treat peptic ulcer disease. The regimen will consist of bismuth subsalicylate, tetracycline, and cimetidine [Tagamet]. The nurse will include which information when teaching this patient about this drug regimen?
   a.
   Black discoloration of the tongue and stools should be reported immediately.
   b.
   Central nervous system depression and confusion are likely to occur.
   c.
   Decreased libido, impotence, and gynecomastia are reversible side effects.
   d.
   Staining of the teeth may occur and is an indication for discontinuation of these drugs.

Answer 5

C

Question 6

6.	When metronidazole [Flagyl] is a component of the H. pylori treatment regimen, the patient must be instructed to do what?
a.
Avoid any alcoholic beverages
b.
Avoid foods containing tyramine
c.
Take the drug on an empty stomach
d.
Take the drug with food

Answer 6

A

Question 7

7. The nurse is providing education to a patient who has been prescribed both an antacid and cimetidine [Tagamet]. Which instruction should the nurse give the patient about taking the medications?
   a.
   “Take the antacid 1 hour after the ranitidine.”
   b.
   “The antacid and ranitidine should be taken at the same time for better effect.”
   c.
   “Take the antacid 15 minutes before the ranitidine.”
   d.
   “Take the antacid 30 minutes after the ranitidine.”

Answer 7

A

Question 8

8.	A patient is diagnosed with Zollinger-Ellison syndrome. Which medication does the nurse expect the provider to order for this patient?
a.
Cimetidine [Tagamet]
b.
Esomeprazole [Nexium]
c.
Ranitidine [Zantac]
d.
Sucralfate [Carafate]

Answer 8

C

Question 9

9. An older adult patient with severe gastroesophageal reflux disease (GERD) has had only minimal relief using a histamine2-receptor antagonist (H2RA). The patient is to begin taking omeprazole [Prilosec]. What will the nurse teach this patient?
   a.
   A complete cure is expected with this medication.
   b.
   Lifestyle changes can be as effective as medication therapy.
   c.
   Long-term therapy may be needed.
   d.
   The medication will be used until surgery can be performed.

Answer 9

C

Question 10

10. A patient stops taking a proton pump inhibitor (PPI) after 6 weeks of therapy for treatment of peptic ulcer disease. The patient reports symptoms of dyspepsia to the nurse. The nurse will tell this patient to:
    a.
    come to the clinic to be tested for Clostridium difficile.
    b.
    resume taking the PPI, because long-term therapy is necessary.
    c.
    resume taking the PPI until symptoms resolve completely.
    d.
    try an antacid to see whether it relieves these symptoms.

Answer 10

D

Question 11

11. A nursing student is caring for a patient who is taking sucralfate [Carafate] and ciprofloxacin [Cipro] to treat peptic ulcer disease. The student asks the nurse about the pharmacokinetics of sucralfate. Which statement by the student indicates a need for further teaching?
    a.
    “Sucralfate adheres to the ulcer and blocks the back-diffusion of hydrogen ions.”
    b.
    “Sucralfate and ciprofloxacin should be administered 1 hour apart.”
    c.
    “Sucralfate does not cause systemic side effects.”
    d.
    “Sucralfate has a moderate acid-neutralizing capacity.”

Answer 11

D

Question 12

12. A patient who has gastroesophageal reflux disease (GERD) receives a prescription for a proton pump inhibitor (PPI) medication. What will the nurse include when teaching the patient about this drug?
    a.
    “The FDA has determined that there is a gastric cancer risk with this drug.”
    b.
    “This drug will be given on a short-term basis only.”
    c.
    “You may experience hypermagnesemia when taking this drug.”
    d.
    “You should report any fever and cough to your provider.”

Answer 12

D

Question 13

1.	Which non-pharmaceutical intervention can be used to reduce symptoms of gastroesophageal reflux disease? (Select all that apply.)
a.
Avoiding late-night meals
b.
Consuming a glass of wine with meals
c.
Drinking soft drinks
d.
Losing weight
e.
Stopping smoking

Answer 13

A. E.

Question 14

2.	Which are potentially worrisome adverse effects associated with proton pump inhibitor use in older patients? (Select all that apply.)
a.
Gastric cancer
b.
Headaches
c.
Medication interactions
d.
Osteoporosis
e.
Vitamin and mineral deficiencies

Answer 14

C. D. E.